Inequality kills

The World Health Organisation are presenting their findings of a three year investigation into the ‘social determinants of health’ today. The report is available here. We are all used to hearing that the latest health news is ’shocking’ and ‘appalling’, but this report is a rare exception – it does actually deserve these descriptions. Life expectancy in one part of Glasgow is falling with a 28 year disparity in one part of the city compared to another. Maternal mortality in Indonesia is 3-4 times higher in the poor compared to the rich. They say “In the United States, 886 202 deaths would have been averted between 1991 and 2000 if mortality rates between white and African Americans were equalized”.

The report is rather brave. It talks about things like ‘social justice’ as a way to tackle health inequalities; for example, the importance of good urban developments, the need for fair and decent work, comprehensive social protection, the need for quality and equity in primary health care, and the problems with ‘practices that tolerate or actually promote unfair distribution of and access to power, wealth, and other necessary social resources’.

At the moment the best we seem to be doing to reduce health inequalities is to medicate more people with statins and antihypertensives. The ‘inverse care law’ as described by Julian Tudor Hart, suggests that the more people need medical care, the less they receive it, and I think this is true today. However I do not believe that real improvements in health can be tackled by addressing just access to healthcare. There is only so much that medication can do: low aspirations, unfulfilling employment, financial distress, a lack of  control over one’s life, and little social cohesion have a huge influence on the quality of life and health. These need to be addressed holistically: ‘social justice’ is the right term for it.  

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